Page 17 - Boca Club News - October '22

Boca Club News, Page 17
Medical Matters:

Pernicious Anemia

By Richard Nagler, M.D., a member loss of balance, hallucinations, delusions, muscle spasms, Vitamin B12 supplements should be used with caution in
of Broken Sound Club and retired memory loss, confusion, depression, peripheral neuropathy those with coronary artery disease, high blood pressure,
physician. After graduating from with numbness of hands and feet, and atrophy of the optic any cancer, skin disorders, genitourinary concerns, low
the University of Pennsylvania nerve with vision problems. In addition, complications are potassium levels, gout and other blood disorders.
and New York University’s School common which include an increased risk of gastric polyps, Researchers had previously believed that vitamin B12,
of Medicine, Dr. Nagler served stomach cancer, bone fractures—especially of the upper when combined with folic acid, can prevent diseases of the
his internship and residency at leg and forearm—and digestive tract problems including heart and blood vessels by reducing levels of amino acid
Baltimore City Hospital and Johns difficulty swallowing. in the blood (homocystine). However, studies show that
Hopkins. He followed that with a The diagnosis is made by a CBC, where the number this combination doesn’t reduce the risk of cardiovascular
Fellowship in Gastroenterology at Yale University School and size of the RBC’s can be determined. A reticulocyte disease and stroke.
of Medicine, and was then Chief of Gastroenterology count, a bone marrow examination, test for MMA (methyl While vitamin B12 deficiency is associated with
at Fitzimmons General Army Hospital in Denver. He melonic acid), level of homocystine, and a vitamin B12 test dementia and low cognitive function, there is no good
returned to the Yale Medical School for one year as an which will reveal low levels of the vitamin in the blood. evidence that Vitamin B12 supplements prevent or treat
Assistant Professor of Medicine before opening his own Antibodies can be detected against IF, and a biopsy of the dementia. There is no evidence that vitamin supplements
successful private practice in Internal Medicine and stomach wall can reveal damaged or dead cells involved will boost energy. Seniors especially should take vitamin
Gastroenterology. During that time, he also served for with production of IF. B12 supplements with caution.
ten years as Chief of Medicine at Huntington Hospital in There are a number of risk factors, such as a family Other diseases associated with macrocytic anemia
Huntington, N.Y. history, over age 60, people of northern European or and vitamin B12 deficiency are Addison’s disease,
Pernicious anemia is one of the Vitamin B12 deficiency Scandinavian descent, type 1 diabetes and those who have hyperthyroidism, hypothyroidism, myasthenia gravis,
anemias that affect two percent of Americans. It is an auto- had surgical removal of part of the stomach or terminal ovarian failure after 40, testicular dysfunction, celiac
immune disease in which vitamin B-12 is not absorbed ileum. disease, auto immune diseases such as Lupus and
because the body’s immune system makes antibodies that Treatment involves self-administered vitamin B12 Sjorgren’s syndrome, Crohn’s disease with disease in
attack and destroy the cells in the lining of the stomach injections daily or weekly until normal blood levels of the the terminal ileum where vitamin B12 is absorbed, those
that produce a protein IF (Intrinsic Factor). vitamin are attained. Then injections once a month will who have had a gastric bypass for obesity, COPD and
In normal people IF binds with Vitamin B12 in the suffice. Vitamin B12 pills, nasal sprays and gels are a less alcoholism.
stomach, which is essential to making it available to effective option. There are many agents linked to low levels of vitamin
be absorbed in the terminal ileum of the small bowel. It is important to understand that there are also other B12: Methotrexate, angiotension enzyme converting
Pernicious anemia is a macrocytic anemia in which a lack causes of macrocytic anemia. A deficiency in vitamin B12 inhibitors, chronic use of certain antibiotics as neomycin
of B12 causes the bone marrow to produce abnormally is seen in people who follow a strict vegetarian diet, as and aspirin in larger doses, colchicine, nicotine, H2
large RBC’s (red blood cells) called macrocytes which, plant foods do not contain Vitamin B12. The vitamin is blockers and protein pump inhibitors, and some anti-
because of their large size, may not be able to leave the found in red meat, poultry, shell fish, eggs, cheese, liver, seizure medications. Finally, there are some agents that
bone marrow and enter the blood stream, thus causing kidney, dairy products, fortified soy, nuts and rice milk. interfere with the absorption of the vitamin, such as folic
anemia. Although best obtained from food sources, vitamin B12 acid, vitamin C and potassium.
Because of the diminution of oxygen carrying blood oral supplements in dosages of 25 to 100 mg per day are
cells, these people will experience a myriad of symptoms: available when there is a deficiency of the vitamin.
weakness, weight loss, persistent headaches, loss of However, too much of the vitamin is implicated in
appetite, constipation, heartburn, nausea, pale skin, recurrences of narrowing of arteries after stents, elevated
shortness of breath, a swollen red tongue and bleeding blood pressure, episodes of gout, cough, rash, itching
gums and heart damage. Neurological symptoms are also burning skin, peripheral edema, dizziness, joint and
prominent due to nerve damage, such as unsteady gait, muscle pain, facial flushing and low levels of potassium.
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